CME Course

Impact of Do-Not-Resuscitate Orders on Nursing Clinical Decision Making

Although previous studies have evaluated how the code status of patients may affect physician decisions, this is the first study to evaluate how code status may affect the decisions of bedside nurses.

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Target Audience

Southern Medical Journal (SMJ) is an interdisciplinary, multi-specialty Journal, and articles span the spectrum of medical topics, providing timely, up-to-date information for primary care physicians and specialists alike. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.  Therefore, the readers of the SMJ are an appropriate target for this article.

Goals and Objectives

Code status specifies the action that healthcare provider should take in the event of cardiac arrest. Studies have shown, however, that patients with do-not-resuscitate/do-not-intubate (DNR/DNI) orders have worse outcomes and do not consistently receive the standard of care. Several studies have demonstrated that physicians behave differently toward patients with DNR/DNI orders, but little research exists into whether DNR/DNI status affects the practice of other members of the care team. The author’s objective was to determine whether code status affects decision making by nursing staff. At the conclusion of the session, learners should be better prepared to:

  • Recognize that apart from just withholding advanced life support and / or endotracheal intubation, the usual care practices of physicians and nurses may be impacted when a “do not resuscitate / do not intubate” is activated for a patient;
  • Describe patient morbidity that may result when a ”do not resuscitate / do not intubate” order is issued for a patient;
  • Recognize that a simple “do not resuscitate / do not intubate” may create ambiguity or less personalized advanced directives.

Course Information

CME Release Date: July 8, 2020
Valid for credit through: July 8, 2021
Course type: CME Journal Article
Estimated time of completion: 1 hour

Credits Available

Southern Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Southern Medical Association designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

AANPCP: The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Healthcare Professionals
For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.  All healthcare professionals who are not MDs or DOs will receive a certificate of participation.

Instructions for Participation and Credit

This activity is designed to be completed within the time designated; learners should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period noted, following these steps:

  • Read the course description, accreditation information, and disclosure information.
  • Login to access the course content and resources for further study.
  • Complete the activity evaluation and attestation.

Upon successful completion of the test, evaluation and attestation, your certificate will be processed and emailed from customerservice@sma.org within approximately 1 hour. Credits will be archived for 6 years; at any point within this time period you may login to your account to print a duplicate copy of your certificate.

Disclosure of Relevant Financial Relationships

As an organization accredited by the ACCME, Southern Medical Association requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner that could create a conflict of interest.

Southern Medical Association encourages Speakers/Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

The following individuals, unless otherwise notedhave no relevant financial relationships to disclose.

Manuscript Author(s):
Rebecca Engels, MD, MPH
Casey Graziani, MD
Ixavier Higgins, BS
Jessica Thompson, NP
Roberta Kaplow, PhD, APRN-CCNS
Theresa E. Vettese, MD
Annie Massart, MD

SMJ Editor-in-Chief:
Steven T. Baldwin, MD

Southern Medical Association/Southern Medical Journal Editorial Staff:
Jennifer S. Price, MA, Managing Editor
Anita McCabe, Copyeditor

Course Materials

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this course or view your purchase options.

Purchase this course now ($10)

Create a free account, then purchase purchase access to this course.

Purchase a membership plan (fees vary)

Premium members can access all courses plus recieve many more benefits. View all membership plans and benefit packages.